TOPIC GUIDE: Organ Donation

"We should introduce a system of presumed consent for organ donation"

PUBLISHED: 31 Jan 2012

AUTHOR: Jason Smith and Tony Gilland

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INTRODUCTION

When the first successful kidney transplant took place in Boston in 1954 and the first human heart in South Africa in 1967, they were hailed as triumphs for modern medicine. Nowadays transplants are relatively common procedures: according to the British Heart Foundation [Ref: BHF], more than 5,850 heart transplants have been conducted in the UK, and patients can go on to live very active lives, some even running Ultra-marathons [Ref: Heart Transplant]. The latest NHS figures list 3,740 organ transplants as being carried out in 2010/11 [Ref: UK Transplant]. However, there are a further 10,000 people waiting for a transplant, and a lack of donors means that a percentage of these patients will die while on the waiting list. This situation has prompted successive governments to look at the system through which organs are donated – currently a voluntary ‘opt-in’ system, where the donor identifies him or herself by carrying a Donor Card [Ref: Sun]. Since 2000 the British Medical Association (BMA) has called for the introduction of an ‘opt-out’ or ‘presumed consent’ system for organ donation, where individuals would have to actively ‘opt-out’ if they do not wish to be considered donors upon death. But critics of presumed consent argue that such a step would effectively make all our vital organs national property. Is it our moral duty to donate organs to save the lives of others or is this an example of government trying to take personal decisions for us?

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DEBATE IN CONTEXT

This section provides a summary of the key issues in the debate, set in the context of recent discussions and the competing positions that have been adopted.

The organ donation debate in context
In many European countries, including Austria, Belgium, Spain and France the ‘opt out’ law prevails where a person is presumed to have given consent unless they have formally recorded their objection to being a donor. However, it remains customary for the question of donorship to be discussed with relatives, even if it is not required by law. In the UK, the Human Tissue Act 2004 makes donation lawful only when a person has given consent prior to their death [Ref: National Archives]and relatives have no right to veto this decision as the patient’s wishes are considered paramount [Ref: HTA]. Supporters of presumed consent point to the far higher donation rates achieved in countries that operate some form of opt-out system. Spain has 33.8 organ donors for every million people of its population – three times the UK rate of 12.9 per million. One reason for this differential is that in the UK roughly only 19 per cent of the population have signed up to the donor register, despite surveys showing up to 90 per cent support donation [Ref: UK Transplant]. However, Sweden, which has an opt-out system, also has a low donor rate (15 donors/million). The British Medical Association points out that presuming consent is more likely to respect the wishes of the deceased person, and would relieve relatives of the burden of decision making in the absence of clearly stated wishes from the deceased [Ref: BMA]. Yet patient representatives Patient Concern argue that organ donation is a generous gift, not an obligation [Ref: Patient Concern]. Rather than alter rules around consent, they insist that the government should introduce new systems to boost organ transplants – including more transplant co-ordinators, more intensive care beds, more organ retrieval teams, and more public awareness.

What about personal autonomy and respect for individual beliefs?
A Public Research Report carried out in September 2008 for the Organ Donation Taskforce found that the main objections to an ‘opt out’ system of presumed consent related to concerns around the infringements of human rights and civil liberties [Ref: National Archives]. A sizeable minority thought that a system of presumed consent could undermine individual choice, and would hand decision-making about our own bodies over from the individual to the state. Journalist Mick Hume, writing in The Times when former Prime Minister Gordon Brown backed an ‘Opt-out’ system, underlined the importance of personal autonomy, arguing that whilst ‘the dead body is no longer a person’ neither ‘should it automatically be assumed to be a national asset’. Hume further notes the proposal has the potential to undermine trust in the medical profession, whereas a high profile campaign to persuade patients this is the humane thing to do could win widespread public support. But others disagree. Polly Toynbee, the Guardian columnist, counters that opposition to presumed consent is based on superstition and scaremongering led by ‘a few vociferous people’s misguided and primitive instincts about the sanctity and integrity of corpses’.

Financial incentive or betrayal of altruism?
For some the notion of providing financial incentives for organ donation has uncomfortable associations with the emerging black market in the sale of organs across the developing world. But others observe that the market in ‘transplant tourism’ is fuelled by a shortage of donors in the West: encouraging greater participation at home would at least counter some of this problem [Ref: Wales Online]. Israel has recently introduced legislation that offers a non-ﬁnancial incentive to consent, namely preferential access to transplantation for individuals who join the Organ Donor Registry (ODR) [Ref: BBC News]. The Ethics Committee of the American Society of Transplant Surgeons concluded that direct cash payment to families violated the ideal of altruism upon which donation should be based; however, payment of funeral expenses or a donation to a chosen charity was deemed acceptable and compatible with the concept of donation as a gift [Ref: ASTS]. The Nuffield Council on Bioethics has suggested that the government should pilot a scheme to examine whether there is public support for the idea of meeting funeral expenses, and whether it would increase the number of people signing up to the organ donor register [Ref: Nuffield Council on Bioethics].

ESSENTIAL READING

It is crucial for debaters to have read the articles in this section, which provide essential information and arguments for and against the debate motion. Students will be expected to have additional evidence and examples derived from independent research, but they can expect to be criticised if they lack a basic familiarity with the issues raised in the essential reading.

KEY TERMS

Definitions of key concepts that are crucial for understanding the topic. Students should be familiar with these terms and the different ways in which they are used and interpreted and should be prepared to explain their significance.

AUDIO/VISUAL

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